Project Abstract This project (PRescribing INterventions for Chronic pain via the Electronic health record (PRINCE) study) will develop and test a novel EHR-based intervention based on principles from behavioral economics to encourage appropriate opioid prescribing for chronic pain, as stated by the CDC?s guidelines. Chronic pain is highly prevalent, affecting an estimated 11% of the U.S. adult population. Opioids are commonly used for treating pain with prescriptions nearly doubling between 2000 and 2010 among all pain visits, and the morbidity and mortality consequences of opioid use are becoming increasingly severe. Primary care is a key target for improving treatment of chronic pain and reducing risks from inappropriate opioid use. Non-malignant pain is one of the most common reasons for primary care visits and primary care providers (PCPs) account for nearly half of all opioid prescriptions. Recent CDC guidelines define a pathway to improve appropriate opioid prescribing, and the guidelines? target audience include PCPs such as physicians, nurse practitioners, and physician assistants. The challenge is knowing how to change the treatment and prescribing behavior of PCPs to be more concordant with these guidelines, as changing provider behavior is difficult. In the R21 phase of this project, Aim 1 is to design an EHR-based intervention to improve opioid prescribing that prompts PCPs to justify their decision to initiate an opioid prescription. Aim 2 is to pilot-test the interventions to ensure they work in the clinical setting as intended. Aim 3 is to define outcome measures relevant to the CDC guidelines and demonstrate that they are captured by EHR. In the R33 phase of this project, Aim 1 is to implement a clinic- randomized intervention to evaluate the effectiveness of the interventions. The researchers will randomize the intervention across 40 primary care clinics over a 12-month intervention period. Aim 2 is to collect data from the EHR system, and web-survey data from PCPs for analysis. Aim 3 is to analyze effects of the intervention on the primary and secondary outcomes, and disseminate results. To complete these aims, the academic research team will partner with two delivery systems. The experimental design will facilitate comparing the effectiveness of two variants of the intervention, and will facilitate testing whether different doses of the intervention differentially affect provider behavior. The results from this project will provide crucial evidence on how primary care providers can be encouraged to deliver more appropriate opioid treatment for chronic pain, in a way that leverages EHR technologies while being as unobtrusive to providers? workflow as possible.